Clinical Aspects of Hypertension

A number of controversies concerning clinical aspects of hypertension are addressed. These include the need for out-of-the-office blood pressure readings in order not to incorrectly label the many people who have “white-coat” elevations of pressure as being hypertensive. A second issue is determining the need for antihypertensive drug therapy after institution of an appropriate program of lifestyle modifications. Emphasis is placed upon the need to go beyond the level of blood pressure and to incorporate both the degree of target organ damage and the presence of concomitant cardiovascular risk factors in deciding upon the need for drug therapy. Once therapy is begun, the choice of initial therapy should be based upon certain demographic features and, mainly, the concomitant conditions that may be either adversely or positively influenced by the agent chosen. Since a J-curve of coronary disease likely exists, caution is advised not to lower the pressure below the lower limit of coronary perfusion. Lastly, the potential for prevention of hypertension is supported. (Hypertens Res 1994; 17: 205 213).